Current status of renal replacement therapy in Cuba 2006.

We present the main structural and organizational features, as well as the human resources and the activities of Cuba in nephrology, dialysis, and transplantation. Access to renal replacement therapy is universal (not restricted). There are 47 hemodialysis services. There are 281 renal physicians (216 serving adult patients and 65 pediatric nephrologists). The incidence of renal replacement rose from 71 per million population (pmp) in 2000 to 98 pmp in 2006. The prevalence of patients on dialysis treatment increased from 100 pmp in 2000 to 194 pmp in 2006. Growth rates for dialysis increased by an average of 10.6% annually in this time. The overall prevalence of patients increased from 156 pmp in 1999 to 275 pmp in 2006. The main cause of endstage renal disease was diabetes mellitus. Main causes of death on dialysis were cardiovascular disease (43.7%) and infectious disease (22.8%). Ninety percent of the organs were retrieved from cadavers. The cadaveric donation rate was 10 pmp. Cuba shares economic limitations with its neighbors but is one of the emerging world's least socially stratified countries, with a universal, free public healthcare system emphasizing primary health care and prevention in nephrology.

Día mundial del riñón y nefrologia en Cuba: tratar algo más que la enfermedad renal / The World Kidney Day and the nephrology in Cuba. Treat something more than the kidney disease

Las enfermedades renales son frecuentes, perjudiciales y tratables. Las jornadas internacionales por el Día del Riñón en su segundo año de celebración llama a la acción no sólo a los nefrólogos y pacientes renales, sino a médicos de todas las especialidades, enfermeras, científicos, expertos, administradores, gobiernos, para que estén conscientes de los desafíos que representa la Enfermedad Renal Crónica (ERC). En este artículo, se analiza el desarrollo de la Nefrología en Cuba y la relación de la ERC a otras enfermedades crónicas no transmisibles caracterizadas por el daño endotelial. Su prevención, diagnóstico y tratamiento es la vía común para contribuir a disminuir la morbimortalidad cardiovascular internacionalmente(AU)

[Impact of an anti-hepatitis B virus (HBV) immunization program in patients undergoing dialysis in Havana, Cuba]. / Impacto del Programa de inmunización anti-virus de hepatitis B (VHB) en pacientes sometidos a diálisis en La Habana, Cuba.

The follow-up of HBV markers in selected high infection risk populations, in patients from the hemodialysis and peritoneal dialysis services was used to assess the effectiveness of a special vaccination program. Viral infection markers were studied in prevalence cross sections of the whole population of patients, and also by recording the reports of clinical cases of hepatitis B occurred during that period in those groups of patients. The prevention program consisted of the vaccination of all patients negative to the viral markers and the indication of vaccination for the new cases during the period of the kidney disease, just before the start of the treatment at the hemodialysis unit; besides all the persons susceptible to infection that had already been included in the program, regardless of the stage of the disease. The results show the benefit of the vaccination in these patients, but it is more effective in the period before the treatment with dialysis where there is a lower possibility of being exposed to the virus and the immune system is still competent. Once the program was established, after a follow up o 6 years, there have been no reports of new cases of hepatitis B and the incidence of the disease has been declining.

[Plasmapheresis in the treatment of the acute reaction of transplanted kidney rejection]. / Plazmaferez v lechenii ostroi reaktsii ottorzheniia transplantirovannoi pochki.

A total of 14 patients with acute rejection of transplanted kidney were treated with plasmapheresis (in combination with prednisolone supporting therapy in a dose of 15 mg/kg). For the arrest of the rejection it was necessary to use 4 sessions of plasmapheresis on average for each person (from 3 to 8 sessions). The average volume of discharged plasma, 2,000 ml approximately, was compensated with frozen plasma. Plasmapheresis was exercised by plasma separation with an "Asahi" plasma filter with the surface of 0.5 m2. Plasmapheresis successfully arrested the rejection in 50 per cent of the patients. Pathogenetic reasonability of plasmapheresis for the treatment of the aforementioned patients (elimination of toxins, circulating immune complexes, elevation of C3 and C4 components of the complement) was substantiated. In patients who had undergone plasmapheresis for the arrest of acute rejection, lowered levels of proteinuria were considered as a favourable prognostic sign.